Osteopathic Manipulative Treatment and Psychosocial Management of Dysmenorrhea

Participants

• Number: 1
• Description: 32-year-old woman, medical student. At the first visit the patient reported back and hip pain so severe that she had considered not attending her classes. After 3 weeks, at the second visit, she reported having had dysmenorrhea for a week.
  The dysmenorrhea was described as horrible pain and crampingness, capable to last for many hours a day, up to a week, during the perimenstrual period.
  Before the dysmenorrhea the gynecological history was normal: only a mild colic-like pain during her menstrual period, that, however, would not interfere with her daily life. The patient had never had sexual intercourses and pelvic examination and Papanicolaou test were both normal. The only changes in her menstrual cycle were those related to the recently developed pain.

With regard to her family history, the older sister had had a level 3 dysmenorrhea for most of her adult life resolved only through hysterectomy after an unsuccessful hormonal therapy. The patient did not report any physical traumas, except for an abductors strain before the onset of the symptoms. At a psychosocial level, she reported stress due to the coursework of her first year of medical school and, because of her introverted personality, to the cohabitation with a roommate over the last 4 months.

A general evaluation revealed a loss of appetite and inconsistent eating habits. Symptoms like headache, low back pain, mood swings (irritation towards others), mild breast tenderness, nausea, diffuse abdominal pain, constipation and diarrhea manifested during dysmenorrheic periods. On the other hand, no symptoms of menorrhagia, oligomenorrhea, intermenstrual bleeding, mid-cycle ovulation pain, bloating, vomiting, dysuria, urinary retention, vaginal discharge or irritation, or dyschezia occurred.
Cardiopulmonary, neurological and abdominal examinations had normal results. The osteopathic structural examination revealed important asymmetries of the occipitoatlantal joint, thoracic and lumbar spine, sacrum and iliac crests, particularly during dysmenorrhea. Also, the cranial rhythmic impulse was diminished and accompanied by hypertonicity in the suboccipital muscles.

Interventions and evaluations

• 6 sessions of OMT over 5 months. OMT: personalized treatment based on the somatic dysfunctions detected
• Myofascial release, strain-counterstrain, soft tissue, muscle energy, suboccipital release, abdominal plexus release, articulatory, ligamentous and membranous tension balancing techniques
• Discussion of the psychosocial stressors and of the need for adequate calorie intake as well as of the execution of a good aerobic physical activity. As a consequence, the patient undertook a path of mindfulness meditation and yoga on a weekly basis.

Results

Despite back and hip pain resolved after 2 sessions of OMT, the dysmenorrhea persisted over the next 5 months, passing from level 1 to level 3 within 3 months, to then regress again after the treatment. During this period, the somatic dysfunctions gradually decreased, as well as the pain improved, eventually returning to be similar to a mild colic of 10-20 minutes during the menstrual period.
The last 2 sessions of OMT focused on releasing somatic dysfunctions at the pelvic level, particularly at the pelvic diaphragm level. Moreover, the patient came to the decision to stop the cohabitation as too stressful.

At the end of the treatment period, some symptoms of headaches, fatigue and mood swings still occurred during the days following menstruation; however, they resolved in the following month.
During the treatment period, the patient lost about 5kg. Nevertheless, her eating habits regularized thanks to the meditation path undertaken, as the altered diet was a result of the stress experienced.
After a year, the patient confirmed the resolution of the dysmenorrhea and the presence of the usual mild pain during the menstrual period.

Discussion

The combined approach of OMT and stress management, with added meditation, showed to be able to positively influence a particularly painful condition of dysmenorrhea.
Most likely, the dysmenorrhea was caused by a combination of somatic dysfunctions at the pelvic and sacral level and various stressors, which produced an alteration in balance and function of the stress axis (hypothalamus-pituitary-adrenal) and of the autonomic nervous system.

There has therefore been a biochemical, nervous and mechanical stress on the uterus, which, consequently, produced an alteration in muscle tone and uterine blood flow and therefore in the dysmenorrhea.
Future studies are needed to evaluate the effective usefulness of a similar approach and, most of all, to completely understand the efficacy of each single therapeutic modality used.